Over 3 million women deliver vaginally each year in the United States, and most experience trauma to the genital tract with birth. This trauma can cause short and long term problems for new mothers, including pain and other functional impairments. Although lowering the rate of childbirth trauma would benefit many women, preventive measures have not been fully explicated. One factor, which may influence rates of childbirth trauma, is the hand maneuvers used by the birth attendant for perineal management late in the second stage of labor (the pushing or expulsive phase). Beyond limiting the routine use of episiotomies, no evidence supports any specific recommendations or perineal management immediately prior to vaginal birth. This study will assess the effects of techniques used by nurse-midwives on rates of spontaneous lacerations to the birth canal. A randomized trial of 1200 low-risk women will compare three strategies on the likelihood of an intact perineum after birth, with control for confounding variables (maternal age and parity, birth position, style of pushing, size and position of baby at birth, length of second stage, and epidural analgesia). The perineal care measures are 1) warm compresses to the perineum, 2) perineal massage with lubricants, and 3) no touching, that is hands off the perineum until crowning and expulsion of the baby. Patients will be recruited in six ambulatory clinics staffed by certified nurse midwives in Albuquerque, NM. Healthy gravidas at term will be randomized in labor. In second stage labor a staff midwife will perform one of the three-perineal management techniques (list above) prior to vaginal birth. After birth all perineal trauma will be documented by physical exam, and other clinical data recorded. Medical records will also be reviewed at hospital discharge and at the 4-6 weeks office visit to identify any complications/ adverse experiences. This study will identify whether any technique is superior for trauma reduction, and will generate evidence to inform the practice of all clinicians who work with childbearing women: nurses, nurse-midwives, family physicians, and obstetricians.